The association between non-ventilator associated hospital acquired pneumonia and patient outcomes among U.S. Veterans - 29/11/22
, Hung-Yuan P. Chen, MPH a, b, Dian Baker, PhD, APRN d, Richard Blankenhorn, MSDA, BSF a, b, Ryan J. Vega, MD, MSHA e, f, Michael Ho, MD, PhD a, b, g, Shannon Munro, PhD, APRN, NP hHighlights |
• | NV-HAP leads to longer length of stay and higher mortality and health care costs. |
• | Data available at admission is insufficient for risk stratification. |
• | Approximately 20% of all sepsis cases were associated with NV-HAP. |
• | Evidence-based prevention efforts should target all hospitalized patients. |
Abstract |
Background |
Non-ventilator associated hospital acquired pneumonia (NV-HAP) affects approximately 1 in 100 hospitalized patients yet risk-adjusted outcomes associated with developing NV-HAP are unknown.
Methods |
Retrospective cohort study with propensity score matched populations (NV-HAP vs no NV-HAP), using ICD-10 codes for bacterial pneumonia not present on admission. Outcomes included the patient level probability of NV-HAP developing among acute care non-transfer admissions in 133 Veterans Affairs hospitals and subsequent mortality, length of stay, inpatient sepsis, and 12-month costs.
Results |
NV-HAP occurred in 0.6% of Veteran admissions. Among admissions that developed NV-HAP, the mean length of stay of 26.3 days (6.72 days among non-NV-HAP), 30-day mortality was 18.4% (4.5% among non-NV-HAP), 1-year mortality was 47.8% (21.4% among non-NV-HAP), and total median 12-month direct medical costs were $138,136.32 ($64,357.21 among non-NV-HAP). Inpatient sepsis occurred in approximately 20% of NV-HAP admissions (0.7% among non-NV-HAP). Data available at admission was insufficient to identify high and low risk patient groups.
Conclusions |
NV-HAP is associated with severely worse patient outcomes and increased costs of care up to 12 months post-episode. Since population risk stratification is not feasible, prevention efforts should be directed at the full population of hospitalized Veterans.
Le texte complet de cet article est disponible en PDF.Key Words : Non-ventilator associated hospital acquired pneumonia, Non-device related pneumonia, Risk stratification, Mortality, Cost, Veterans
Plan
| Acknowledgments: The VA Quality Enhancement Research Initiative (QUERI) program of the VHA Health Services Research and Development Service and the Diffusion of Excellence Initiative funded this approved non-research evaluation (VHA program guide 1200.21) through grant PEC-19-306 conducted under the authority of the VHA Office of Nursing Services. The findings and conclusions in this article are those of the authors and do not necessarily reflect those of the U.S. Government or any of its agencies. This material is the result of work supported with resources and the use of facilities at the Cleveland-Denver-Seattle VA Collaborative Evaluation Center and the Department of Veterans Affairs Medical Center in Salem, VA. |
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| Conflicts of interest: None to report. |
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| Funding Source: QUERI was not involved in designing the study, data collection, analysis, or interpretation of the data, or in writing the manuscript. |
Vol 50 - N° 12
P. 1339-1345 - décembre 2022 Retour au numéro
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